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Home My WebLink About062-440-02962-44-29 Jim Cash NIS Bald Rock Rd., app.l mi.E.of Oro Quincy Hwy, OrovRle contr: T.M.L., Inc., Oroville Permit #48 0-79B,P,E,M(new single family) ji� Per S t CJ 253 BA, n ROCK � { _ RD, BERRY Cxcr1 'Cont: OWNER REROOF .u'i P& MIT NO. 4820-79B,+P,E,M PERMIT EXPIRES. OWNER Jim Cash CONTR. T.M.L., Inc., Oroville LOCATION (A.P. 62-44-29 1 N/S Bald Rock Rd.,.app. 1 mi.E.of Oro Quincy Rwy,.Oroville i; I • Y� 4 e r Temp: Power Pole v Called PG&E l; Temp. ,Elec. Serv. Called PG&E Tempf Gas Serv. Called PG&E JB _ VNALED (Date) c7 (Signa ure) interior t_atn on Z anent Door Closer Ina d loafy6giL l d MOBILEHOMEUTILITIES--------------- --- ec. Service Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS � 9 Pi 70-00 ml - C .-/No 1✓� / COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Z/y If Soil Piping Forms-40 22 Parapets 1st Floo r Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Z Slab Roof Sheathingn a Water Piping- / Piers L- / d9 2 1 Roofing Sewer /2- Gara a Fdn. Vents / 2 % Fixtures Footings Stemwall AbW t Garage Vents7--f- Y -O nsulation �. Water Htr. Heaters Z •, 0 nc? Slab Carport Footings Prov. for ph sically handica ed Conf ance of ex. Appliances Gas Piping & Temp. Gas �j 9-0 est Slab InalZ on Patio FIREPLACE nal. LS 8 Footings Footin %LECTRICAL Masonry Walls Throat Rou h%2/ - Reinf. Steel Final Fixtures • �-o Bond Beam-F1 13E SPRINKLERS Motors 2-41 , O Framing Test Water. Htr. Stucco Final Subpanels �- Mesh r M CHANICAL Grd. Fault Prot. l Scratch HeatinLzzg Service Brown Cooling Temp. Pole Finish Ducts /^/1-7 C—j Underground interior t_atn on Z anent Door Closer Ina d loafy6giL l d MOBILEHOMEUTILITIES--------------- --- ec. Service Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS � 9 Pi 70-00 ml - C .-/No 1✓� C1/ /"•'tom•-�. ��'�� 9-V a � f M E C H A N I C A L !' - Ir T 4 a#- Permit lUnde floo Sta e nderfloor Supply Plenum: (1) One -story. -(2) Clearances. (3) Combustible material. (4) Insulation and vapor barrier. (5) Access. (6) Catch receptacles and registers. (7) Fire -stopping. (8) Boots. (9) Supply ducts. (10) Gas lines and plumbing cleanouts. ucts: (1) Size. (2) Materials. (3) Support. (4) Fittings. (5) Wrapping. (6) Insulation. (7) Clearances - ground, crawlspace, cleanouts, plumbing, etc. ❑ Combustion Air: (1) Size. ❑ Refrigerant Piping: (1) Material. (2) Support. (3) Fittings. (4) Insulation. ❑ Framing Stage ❑ Heating: (1) Approved appliances. (2) Accessibility..(3) Clearances. Y° (4) Combustion air. ent and Connector: (1) Approved. (2) Size. (3) Clearances. (4) Cap. (5) Termination. ❑ Ducts: (1) Materials. (2) Size. (3) Support. (4) Fittings. (5) Insulation. (6) Fire Damper. ❑ Refrigerant Piping: (1) Material. (2) Support. (3) Fittings. (4) Insulation. (5) Condensate drain. Final ❑ Heating: (1) Accessibility. (2) Combustion air. (3) Safety controls. (4) Electrical connection. (5) Fuel shut-off. ❑ Cooling: (1) Accessibility. (2) Support. (3) Controls. (4) Pressure relief valves. (5) Class 2 refrigerant. 5/79 P L U M B I N G Check List El Permit Unde oor Stage Ur D.W.V.: (1) Sizing. (2) Materials. (3) Fittings. (4) Grade & Support. (5) Cleanouts & Accessibility. (6) Clearances. (7) Rough -in Locations. �* (8) Wrapping. (9) Test - including "Ts". (10) Additional test not fequired.* (1) Sizing. (2) Materials. (3) Support. (4) Test. (5) Wrapping. �* (6) Dissimilar metals. (7) Service regulator.installed or not required.* E] Gas: (1) Sizing. (2) Materials. (3) Support. (4) Log Lighter. (5) Wrapping. Frami Stage (Top Out D.W.V.: (1) Size. (2) Vent Area & Termination. (3) Materials. (4) Fittings. (5) Grade & Support. (6) Cleanouts. (7) Traps. (8) Nail Protection. (9) Plumbing Access. (10) Toilet Clearances. (11) Shower size. (l:2) Shower Pan Test. (13) Vents - turns, horiz., runs, loop, wet, etc. ❑* (14) Additional 2nd floor test not required.* Water: (1) Pipe Test. (2) Mixer Valves. (3) Support. (4) Roof drains. Gas: (1) Size. (2) Materials. (3) PR Valve Drain. 13 Water Heater: (1) Vent. (2).Location;:(3).PR Valv6 Drain. Q Final D.W.V.: (1) Connected to sewer system. (2) Special systems. 11 Water: (1) Water Source. (2) Shut-off. (3) Anti -siphon Valves. Gas: (1) Test. (2) Connectors. 0 Water Heater: (1) Location. (2) Accessibility. (3) Clearances. (4) Stability. (5) 18" Garage Floor. (6) Mechanical protection. (7) Combustion Air. (8) Draft Diverter. (9) Vent Connector. (10) Vent. (11) Shut-off and connector. (12) PR Valve & Drain. Fixtures: (1) Approved. (2) Stability. (3) Clearances. (4) Trapped. (5) Connections. (6) Cross -connections. (7) Dishwasher Air Gap. 5/79 T M L Permit# INSULATION CERTIFICATION Bald Rock Road _ y Number and Street El 1y ROOF Material Thickness (inches) EXTERIOR WALL bdivlslon Lot Number DESCRIPTION OF INSTALLATION r Brand Name Thermal Resistance (R Value) County C ~ Material Fiberglass _ e nd Name Certainteed Thickness (inches) 3 Ztt Thermal Resistance (R Value) CEILING Batt or Blanket Type Fiberglass Thickness (inches) loll Loose Fill Type Minimum Thickness (inches) Area Covered (ft21 FLOOR,ELEVATED Material Fiberglass Thickness (inches) 611 FLOOR, SLAB Material .f Thickness (inches) r Width (inches) FOUNDATION WALL Material Thickness (inches) HEATING�SYSTEM Gas Furnace Make Rated Bonnet Capacity Brand Name Certainteed 1 Thermal Resistance (R Value) 30 Brand Name r Number of bags_ Weight per bag Ib Thermal Resistance (R Value) Brand Name Certainteed �j Thermal Resistance IR Value) 19 r� Brand Name Thermal Resistance (R Value) and Name Thermal Resistance (H Value) DECLARATION I hereby certify that the above insulation was installed in the building at the shove location ir conformance with the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 74 of the California Administrative Code). neral Contractor (builder) License Number Signature and Title Date Hawking Tnsulation Co_Tnn- 378407 Sub Contractor (Insulation Applicator) 9�s�s.- License Number 12-21-79 Ti Signature and tle Dale CERTIFICATE REVIEWED BY I`ate BIN -029 (Building Inspection Office) RESIDENTIAL ENERGY CONSERVATION STANDARDS CONSTRUCTION COMPLIANCE CERTIFICATE THIS IS TO CERTIFY THAT ENERGY CONSERVATION REQUIREMENTS HAVE BEEN INSTALLED IN CQNFORMANCE WITH CURRENT ENERGY CONSERVATION REGULATIONS AT (location) 091 BU ILD ING PERMIT NO. eI-T-2.0 - /rt A ; P . NO. THE FOLLOWING HAVE BEEN INSTALLED AS PER APPROVED PLANS: (Check each item or write N/A if not applicable) INSULATION: Slab Edge. Fdn. Walls Floors Walls - !/ Ceiling/Roof_ 0 Ducts !� Circulating Pipes APPROVED HEATER !� APPROVED WTR.HTR- GLAZING: Single Glazed Special ( Insulated) vyvl� CERT. & LABELED WDS. & SLIDING DRS. WEATHERSTRIPPED DRS. BACK DAMPERED FANS_ INTERMITTENT IGNITION bEVICES --� CERT. APPLIANCES I DECLARE THAT ALL REQUIRED ITEMS AS NOTED ABOVE HAVE BEEN INSTALLED IN ACCORDANCE WITH THE ENERGY CONSERVATION REQUIREMENTS AND AGREE TO THE COMPLETENESS OF THIS CERTIFICATE AS SUBMITTED. / Insulation Applicator Name ,#AW Ki Ats isu LA n: At - Signature -Signature of (please print) Insulation Applicator State Contractors /License No.37r 41)) ! General • Contractor/Owner Name .1yy..Ne-- (please rint) Signature of �.;. .. General Contractor/Owne J Datej. - 8 "'Lfo State Contractors License No. -3 /Qq THIS CERT IF ICATE MUST' BE ON FILE WITH THE BU ILD ING DEPARTMENT PRIOR TO REQUESTING FINAL INSPECTION AND SHALL BE POSTED IN A CONSPICUOUS LOCATION WITHIN THE DWELLING. I COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, - Oroville, California 95965 P /�nTelephone: 534-4541 �/O-,7 �JAPPLICATION AND PERMIT t/j � aumonze represenrarlves or me county or tsurre ro enrer upon me above-mentioned property for inspection purposes. X Date Signature of Permitee or Agent Receipt No. 0&4& White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF WBLIC WORKS % BYJZ :- Date U2g Building permit expires Date7 BUILDING OwnerSQ. FT. OCC. BUILDING VALUATION Mailing A ress 14 g Telephone No. Contractor r In,L. a Mailing Address Fireplace Total Valuation Telephone No. Permit Fee Building AddressPlan Checking Fee&/or Penalty Permit Fee $ 146S lie PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. No. �- / VLoning & P "ing Water piping 1.50 Each gas water heater or vent 1.50 F s Sa ' on Fire Dept. Fire Zone Use P rmit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans I Parcel Declaration ts- Arcel Nlap' 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 Bldg. P ns Recd Parcel royal Plans proval Law s r' ler SYS m 2.00 NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ Permit Fee $ 14 SO $ � ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 3 =Ej Main service 600V OR LESS 100 AMP OR LESS 5.00 Single Family Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L 100 AMP 2.50 Main service OVER s O 25.00 100 AMP OR LESS Main service EA. ADD'L 10000 AMP 1.00 NEW CONST. OR ADDNS. ( ACC. BL DWELLING Z10 0) 20sgft CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: 4L 7-- AA L s� i r NEW CON5TR. (MULTI.OUTL T NON.RESID. BRANCH CIRCUITS 2.50ea NEW CONSTR. (POWER APPARATUS 8 NON.RESID. `SINGLE OUTLET CIR, Ex. OccuD(OUTLETS OR FIXTURES B L@; FIXED APPLNS, OR EX. Occup.(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No..3 2 6Id y Classification Misc. Wiring EJ 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ s a < MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE I am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ®I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. PERMIT FILING FEE 1$3.00. Heating Cooling Ventilation Hood 2.00 Permit Fee $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby Land Development Fee $�.S`� TOTAL PERMIT FEE $ aumonze represenrarlves or me county or tsurre ro enrer upon me above-mentioned property for inspection purposes. X Date Signature of Permitee or Agent Receipt No. 0&4& White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF WBLIC WORKS % BYJZ :- Date U2g Building permit expires Date7 RESIDENTIAL PLAN CHECKING GUIDE (S.F., DUPLEX, & MISC. ONLY) Bldg. Permit # OWNER A.P. # A. GEWALU2- Zoning Zoning requirements (sideyards and parking). Valuation. �J - Signature by R.C.E. or Architect (if required). B. PLQT PLAN Complete parcel size and dimensions. Setbackq, sideyards, easements, etc. Other buildings or structures. Grading, fills,- drainage. C. FL OR PLAN Complete to scale plan with dimensions. Required windows for light and ventilation (Sec. 1405). � � Required windows for second exit (Sec. 1404). �.' Allowable glazing for energy requirements (20% max. per.State law). -5-.""Human impact glass (Sec. 5406). Required room sizes, ceiling heights (Sec. 1407). y G.F.C.I.'s in baths and exterior outlets- .:✓ b.�v.r.n.u...x.....-....rw.+.?r Waw.... _..... r...� .., .8! Light fixtures, switches, receptacles, and .exterior receptacles for maintenan a of _mechanical' equipment ; ....^ �. ` .".`� _ ,..........��. ....... 9f",' Locations of water heater(, heating & cooling equipment) other electrical or ga equipment, and plumbing fixtures:' __ Garage firewall, door size, and closer (Sec. 503(d)(4)). 1 - 3'0" exterior exit door (Sec. 3303d). . Fireplace location. ,f-..� Smoke detectors (Sec. 1413). D. STRUCTURAL DETAILS Foundation plan complete enough to construct building. a! Floor construction details complete enough to construct building. ,3-.' Elevations and wall construction details complete enough to construct building. Roof construction details complete enough to construct building. `'. Fireplace construction details and calcs if over one-story in•height. �Sufficient data and details to satisfy energy insulation requirements (State law). MISCELLANEOUS ITEMS TO LOOK OUT FOR jl. CCX plywood on exposed locations and overhangs. Stairway details (Sec. 3305). Guardrail details (Sec. 1716). Brick or,stone veneer (Chapter 30). Exterior plaster - weep screeds (Sec. 4706 & Proper roof pitch for roof covering (Ch qner 32). dl� Rafter ties or bearing ridge beam.,j... �8a. Garaje: -d_oor orMvorch header_sizes.____...) >91. Adequate bracing. Living area over garage - complete 1 -hour separation required including supporting walls and posts, etc. PC Two (2) exits on three-story dwellings (Sec. 3302). �,, J RMIT NO. 931-80B PERMIT EXPIRES 2/27/81 OYNER < JT NI C-MTJ C I )NTR"'- owner f LOCATION (A.P\ 62-44-29 IS Bald Rock Rd, app 1 mi E Oro @uincy Hwy, Oroville r ;t0vi IA) VA Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. Called PG&E JOB FINALED (Date) (Signature) fi Setback Forms Main Bldg. Footings Stemwal I Slab Piers Garage Footings Stemwa I I Slab Carport Footings Slab Patio Footings Masonry Walls Reinf. Steel COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION'RECGRD, BUILDING BUILDING (Cont'd) PLUMBING Firewall Soil Piping Parapets 1st Floor Restroom Finish 2nd Floor Windows 3rd Floor Siding To out Roof Sheathing Water Piping Roofing Sewer Fdn. Vents Fixtures Garage Vents Water Htr. Insulation Heaters Prov. for physically handica ped Conformance of ex. structure Appliances Gas PI Ing & Test Temp. Gas Final Sanitation FIREPLACE Final Footing EL TRICAL Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole . Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME UTILITIES ------------------ Elec_ Service Elec. Pedestal Water Piping Sewer Gas Piping OBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive , - Oroville, California 95965 Tel dphone: 534-4541 AFIPLICATION AND PERMIT Owner �(Wt Mailing Address Q 5,e 6 z r G �It: Thone No. >`S 3 u_ Contractor Mai I i ng Address Building Address (2,2Z 15A29 a elephone No. A. P. No. (p2 — cl — Z Zoninglig Planning FkCS W69.1 Saaf.t'a'tien Fire Dept. IFireZone Use Permit EQA I Parking p I Parcel Parcel Ma 60' R/W I Improvements Plans Declaration p Bldg. Pfd Parcel Approval I Plans Approval NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER K 0 Single Family Duplex ❑ Mobil Home ❑ Others ❑ CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: License No. Classification 1 I am exempt from the Contractors License Laws of the State of California. WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued 1 shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above- ntioned property for inspection purposes. X U Dat L 7 Signature of iP�erm t�e/e(orr Agent Receipt No. White-D.RW. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant BUILDING SQ. FT. I OCC. I BUILDING VALUA Fireplace I - N d Total Valuation '715 O Permit Fee PERMIT FILING Plan Checking Fee &/or Penalty $3.00 Permit Fee 1000 AMP ORV OR LE SLESS PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Building sewer 5.00 Lawn sprinkler system 2.00 Permit Fee $ ELECTRICAL No. @ PERMIT FILING FEE $3.00 Main service 1000 AMP ORV OR LE SLESS 5.00 Main service EA. AOD'L 100 AMP 2.50 Main service OVER 100 AMPP OR LESS O 25.00 Main service EA. ADD'L 100 AMP 1.00 NEW CONS ADDNST ( DWELING OOR ACCLBLDGS.CCUP. 4� 20sgfI NEW CONSTR. NON.RL51D. MULTI.OUTLT BRANCH CIRCUITS 2.50ei EX. OCCUP(OUTLETS OR FIXTIIRES1 BALD o¢I FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wirina 6.25 Permit Fee $ MECHANICAL iNo. @ FEE PERMIT FILING FEE $3.00 Heating Coolin Ventilation Hood 1 1 2.00 Permit Fee $ Land Development Fee $ TOTAL PERMIT FEE $ This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DI E TOR OF PUBLIC WORKS By Date Z Z Building per t expires Date 2 2 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #; (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BPO53021 - B. C. Building Permit 01-16-04 pg 1 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 11/08/2005 APN: 062-440-029-000 the Business and Professions Code, and my license Is in full force and effect. License Class : License Number: Site Address: 253 BALD ROCK RD BCK Date: Contractor: Map Index: Description: REROOF W/COMP (40) OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: WULFF DEIDRE MARIE permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 253 BALD ROCK RD signed statement that he or she is licensed pursuant to the provisions of BERRY CREEK CA the Contractors Stale License Law (Chapter 9 commehcing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 95916 she is exempt therefrom -and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars ($500).): I, as. owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Applicant: WULFF DEIDRE MARIE Code: The Contractors' Slate License Law does not apply to an 253 BALD ROCK RD owner of property who builds or improves thereon, and who does such work himself or herself or lhrougb his or her own employees, BERRY CREEK, CA provided that such improvements are -not intended or offered for 95916 sale., If however, the building or Improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Prgfessions Code. The Contractors' State License Law does Contractor: not apply to an owner of property who builds or improves'thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code Date: ( /%S Owner: aA;AxL t ll �J License #: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued. Engineer: O 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: carrier: Total Square Ft: 0 S. F. Policy#: Valuation: $0.00 Census Code: ,�� - ---------T—� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' \\V v compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: I I �'t�•� \� O Applicant:f WARNING: Failure to secute workers' compensation coverage is - unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. � ^ c) 4W CONSTRUCTION LENDING AGENCY This permit is' ereb Issued undertheapplicable provisions of the Butte qougfty Co a and/or I hereby affirm that there is a construction lending agency for the Resolutio s to ork Indic d above for which fees have been paid. (1 performance of the work for which this permit is issued (Sec 3097 Civ.) 1 O �J— Name: By: Date: ) �( ,{ 6 // Address: PERMIT EXPIRES V to ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code Is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with .all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County I enter upon the above ed property for inspection purposes; ,. /m'elntio I �t Print Name: I / 1/ZI�I V ( Signature: I 1IWt 9) Date: . ,Owner ❑ Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pg 1 BUTTE COUNTY ►' DEPARTMENT OF DEVELOPMENT SER,�CES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION **PLEASE PRINT CLEARLY** OWNER Last Namer t' irV6;/ P_6 l L ` , � ,� 6-!P" Address &16( 2, S -3 City (2&,, pL/ Stated /,, l/�[ Zip Phone GJ�j� Fax E-mail APPLICANT NAME CONTRACTOR Name a Address Zip City �! State Zip Phone Map Book Fax E-mail Planner Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name City / W( Address Zip City �! State Zip Phone Map Book Fax E-mail Planner State License Num APPLICANT NAME Name Address G P7\A_ J City / W( State C Zip Phone L, /l�, �, J Fax E-mail APPLICANT SIGNATURE X (il J For office use only: Zoning Property Address Z i� c� I�, Flood Zone Cross Street SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS PERMIT NO. 05-3°(21 BP BIN # LOCATION AP# LK O '' 0 Property Address Z i� c� I�, Ci Cross Street Bldg WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: � Gr•I�it � .l��o`F DD s Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 6-16-04 Received by: Amount: 0 G Bldg SRA Receipt #: /� Sheriff 44-0 SMIP Other LDate:,(� OL�,,40 Total K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 6-16-04 SUIITTAL REQUIREMENTS 1 The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BEA CCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPH PAPER! OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed ❑ 3. calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to ❑ 7. mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate,.(C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. ❑ 5. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GRAPH PAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate, (D) Floor plans in triplicate, All of these must be stamped and wet -signed by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538-7541. OVER FOR BUILDING PERMIT APPLICATION KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and material for construction of this proposed property improvement: YES [� ] NO [ ]. 2. I HAVE [)n HAVE NOT signed an application for a building permit for the proposed work. $Qi )-q- 0 3. I have contracted with the followingep rson (firm) to provide the proposed construction: PE TI_M ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: PHONE: CONTRACTOR'S LICENSE NO: I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: I NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTY OWNER: DATE: /) " �-' (_j NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 Butte County Department of Development Services �vT TF ADMINISTRATION; BUILDING `GIS `PLANNING o o 0 0 o o 7 County Center Drive��,0%2 o Oroville, CA 95965, o) l- (530) 538.7541 Telephone (530) 538-2140 Facsimile OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a pen -nit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, C-� Scott Rutherford Chief Building Inspector NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.